Chapter 33
Pastoral Wisdom from the NDE Literature
Pastor David has been visiting Eleanor for thirty years. She taught Sunday school in his church for forty-two. She raised three children, buried a husband, and somewhere along the way taught half the elementary kids in town what a parable was. Last winter her mind began to slip. By summer she did not always know her daughter. By autumn she did not always know her name.
Now it is January. David is standing in the doorway of a small room on the fourth floor of the hospice center. Eleanor is on the bed, eyes closed, breathing in slow uneven pulls. Her daughter sits in the corner, crying quietly. A grandson is texting. The hospice nurse came an hour ago and said it would not be much longer. The room smells faintly of antiseptic. No one is speaking.
David has been to a hundred deathbeds. He has prayed every prayer in the book. And he still stands in the doorway and wonders, every single time, what on earth he is supposed to do.
He sits down beside Eleanor. He takes her hand. He does not say anything for a long minute. Then he begins, quietly, almost under his breath, the only thing he can think of:
The Lord is my shepherd; I shall not want. He maketh me to lie down in green pastures…
The grandson stops texting. The daughter looks up. Eleanor’s breathing does not change. But something in her face does — a faint loosening, a softening at the corners of her mouth. David finishes the psalm. He sits in silence. The daughter says, “She knows you’re here.”
And David — thirty years a pastor, eight times around the *Book of Common Prayer*’s rite for the dying1 — suddenly understands that the daughter has just told him the whole secret of his ministry.
For most of Christian history the local church knew how to attend a deathbed. The ritual was established, the words were known, the people were trained from watching their parents do it. Death happened at home. The pastor came. The neighbors came. The dying person knew what to expect and the people in the room knew what to do.2
The twentieth century broke that. Death moved into hospitals. Pastors were replaced by nurses, family by professional staff, and by the 1970s the average American Christian had never been at a deathbed. The hospice movement — Cicely Saunders in London, Florence Wald at Yale, the slow recovery from the 1980s onward — began to take some of that ground back. But for most pastors today, a hospital-room deathbed is still where they feel most uncertain about what their job actually is.3
This chapter is for pastors. It is also for family members at a bedside, hospice volunteers, lay visitation teams, and chaplains in training. It assumes the theology of dying laid out in Chapter 32 and asks the next question: when you are the one who comes to the bedside of the one who is dying, what do you do?
The answer most pastors were taught — manage the room, comfort the family, lead a prayer, leave — is not exactly wrong. But it is shallow. The NDE evidence we have walked through across this book changes the picture in concrete ways. When you understand what the dying person may actually be experiencing, you understand what your presence in the room is for.
Let me give you eight elements of pastoral presence at a bedside. They are not techniques. They are not steps. They are something more like the contents of a bag you carry in — available to you as the moment requires.
The first is presence itself. Be there. Not to fix anything, not to manage anything — just to be in the room. Most of what the dying person needs from you is simply that you have come. You will be tempted to feel useless. You are not useless. You are the visible sign that the person is not alone. Henri Nouwen, who wrote one of the wisest books on dying ever written, said that ministry to the dying is mostly “the ministry of being there.”4 Trust him.
The second is listening. The dying often speak. Sometimes in clear sentences, sometimes in fragments, sometimes about things that seem disconnected from the room. They may speak of people who are not there. They may speak of light, or of journeys, or of being told something. Do not interpret. Do not correct. Receive it. The dying person is processing something you cannot see. Listen as if what they say matters — because it does.
The third is attending to the out-of-body phase. If the dying person passes through a medical crisis — a cardiac event, a sudden drop in blood pressure, a period of apparent unconsciousness — they may be experiencing what the NDE literature calls the out-of-body phase. NDE accounts repeatedly describe the experiencer hearing every word spoken in the room, sensing whether the gathered family was peaceful or anxious, watching the resuscitation team, and reporting all of it accurately afterward.5 The pastoral implication is enormous: calming the room is itself ministry to the dying person. Speak softly. Move gently. Do not let the room fill with panic. The dying person, if they are above the bed looking down, is taking in everything you do.
If the NDE evidence is even partially what it appears to be, then standard practice at the deathbed must change. We have spent a century treating the unresponsive dying patient as if no one were home. The data say someone is home — and that someone may be hearing every word, watching every face, and registering every emotion in the room. The room is not a stage on which we perform pastoral care for the family alone. It is a place where the dying person is also present, often more acutely than we realize.
The fourth is permission. Many dying people seem to hold on, sometimes for days, until they are released. The hospice literature is full of stories of patients who did not die until the last family member arrived — or, equally, until the last family member finally went home for a shower.6 When the time has come, the family can give permission. “It is okay to go. We love you. We will be okay. Christ is waiting for you.” You may need to coach the family in this. Some have never imagined that their loved one might be waiting for their consent.
The fifth is attending to deathbed visions. The dying often see things the rest of us do not. They see deceased relatives. They see figures of light. They see people in the corner of the room. The medical reflex is to call this confusion or hallucination. The pastoral reflex should be different. Christopher Kerr, the hospice physician at the Center for Hospice and Palliative Care in Buffalo, has now documented thousands of these end-of-life experiences in peer-reviewed research and concludes that they are not delirium — they are coherent, meaningful, and a near-universal feature of dying.7 The historic Christian tradition received them as glimpses of the threshold the soul was crossing. As we saw in Chapter 13, the empirical pattern is consistent with that reception.
The sixth is touch. The dying often respond to touch when they no longer respond to words. Hold a hand. Smooth a forehead. Touching the dying is one of the small holy things a Christian can do.8 Pastors sometimes hesitate, especially with members of the opposite sex, but a held hand is not a confused signal — it is the body of Christ communicating itself through skin.
The seventh is prayer. Pray with the dying. Pray for them. Pray the prayers they loved — the Lord’s Prayer, the Apostles’ Creed, the 23rd Psalm, the 121st, the Sermon on the Mount, John 14. These are connective tissue. They tie the dying person to the church across two thousand years and to the One they are about to see. If you do not know what to pray, pray Scripture. The dying often mouth the words.
The eighth is silence. Sometimes the right thing is to say nothing. The dying do not need to be entertained. They do not need to be cheered up. They may need quiet for the encounter that is approaching. A pastor who is afraid of silence will fill the room with chatter; a pastor who has learned silence will sit beside the dying like Job’s friends did in their first and best week, before they ruined it by talking.9
Several specific findings from the NDE literature should reshape how a pastor or family member behaves at a deathbed. None of these is speculative. All are repeatedly documented across the dataset I analyzed and across the broader literature.
The first is that the dying often hear conversations during clinical death. Cardiac-arrest survivors regularly report hearing precisely what the resuscitation team said, what family members in the waiting room said, what was discussed in adjacent rooms. The dissertation database includes hundreds of such accounts.10 The pastoral implication is direct: speak as though the dying person hears you. Do not speak about them as if they are absent. Do not say in the doorway, “I think she’s gone already,” or, “We’re just waiting now.” Speak as if they are still in the room with you. Because, on the evidence, they may be.
The second is that the dying may see those gathered at the bedside. NDErs frequently describe watching their family from above — noticing who held the patient’s hand, who stood back, who was praying, who was anxious. The room as the dying person sees it is not the room you see. So tend the room as carefully as you tend the patient. Posture matters. Faces matter. Tone matters. A peaceful room is itself a gift to the one in the bed.
The third is that some dying people seem to enter and leave NDE-like states multiple times before final death. Brief returns of clarity, which the hospice literature has long noticed and which terminal-lucidity research is beginning to map carefully, are real and common.11 Watch for them. They are moments for words of love, for blessing, for one last prayer, for “I love you.” Take them when they come.
The fourth is that the deceased may be welcomed at the threshold. Long before contemporary NDE research, the church spoke confidently of the “cloud of witnesses” (Hebrews 12:1) and of the saints who pray with us. The empirical pattern is that the dying often perceive deceased relatives in the moments before death — sometimes those they did not know had died.12 When a dying person says, “Mom is here,” do not contradict them. You are not better positioned to know who is in the room than the person whose soul is on the way out of it.
The fifth is that the transition is often peaceful for those who are spiritually prepared. Pastoral care is not only what happens at the bedside; it is what happens in the months and years before, when you helped the believer face their mortality, walk through their fears, and entrust themselves to Christ. The deepest ministry to the dying is the ministry that started long before they were dying.
Old pastoral training said: when the patient is unconscious, lower your voice and speak frankly with the family at the bedside. The NDE evidence flips that instruction. Speak up, not down. Speak to the patient, not over them. Speak as if every word reaches them — because, on the data, every word may. If you must discuss difficult things with family, step out of the room. The dying person is still a member of the conversation, even when their body has gone quiet.
Let me walk briefly through several cases that pastors and family members ask about repeatedly.
The dying believer. The simpler case, in one sense. Confession if the church practices it; communion if appropriate and possible; the words of commendation; family present; favorite Scripture read; familiar hymns sung quietly; the Lord’s Prayer at the end. There is two thousand years of liturgical wisdom for this moment. Use it. You do not have to invent.
The dying unbeliever. The harder case. The next chapter is given over to it in detail.13 Briefly here: the author’s position is that the encounter at death is not yet over for the unbelieving dying. Christ Himself meets them at the threshold. Our role is to be present, to pray, to love, to bear witness — not to mount last-minute coercive conversion attempts that produce more shame than faith. Chapter 34 develops this fully.
The dying child. The hardest of all. Sit with the parents. Do not try to explain the mystery. Hold the parents and hold the child. Speak of Jesus, who took children into his arms. The historic Christian hope for children is real, and the pediatric NDE literature, as we saw in Chapter 31, is consistent with that hope. But this is not a moment for theology. It is a moment for grief that is not run from.
The sudden, unexpected death. No bedside companioning was possible. The pastoral focus shifts to the bereaved. Be there as quickly as you can. Sit with them. Do not explain. Pray when invited; be silent when not. The grief work that begins now will go on for years.
The unconscious patient. Speak as if heard. Pray as if heard. Read Scripture as if heard. Play music the patient loved if family confirms they would welcome it. Do not stop touching them when they stop responding. The body has gone quiet; the soul, if the evidence of this book is anywhere near right, has not.
The patient with dementia. A tender case. Terminal lucidity sometimes opens a window in the last hours — a moment of unexpected clarity, a recognition of family members not recognized for years.14 Be present so that you do not miss the window. The soul behind the failing brain is more present than the brain’s responsiveness lets on.
A few questions pastors ask repeatedly:
Should I tell the dying person they are dying? Generally yes. Honestly and gently. Most dying people already know. The collusion of pretense — the family pretending the patient does not know, the patient pretending the family does not know — robs everyone of the chance to say what should be said.
Should I read the Bible? If the dying person has loved Scripture, yes. Beloved psalms. The Sermon on the Mount. John 14. Romans 8. Revelation 21–22. Let the words they have known their whole life carry them across the threshold.
Should I share my own grief? Carefully. Do not burden the dying person with your anticipatory grief. But also do not force them to pretend they are not dying for your comfort. A few honest tears are not a burden — they are evidence that the love is real.
What do I say at the actual moment of death? Some pastors say: “It’s okay to go. Christ is waiting. We love you.” Some say nothing and only hold on. Both are right. The moment is yours to attend, not to fill.
Several approaches to the deathbed are common and bad. Naming them is part of training pastors well.
The first is the fix-it approach. The pastor walks in determined to do something — pray a particular prayer, “close” the visit somehow. Death is not a problem you solve. It is a passage you accompany. Your performance is not what is needed.
The second is professional handoff — the assumption that bedside ministry is for chaplains and not for local-church pastors. Hospital chaplains are a gift, but not a substitute. The dying person’s pastor — the one who baptized them, married them, buried their parents — carries a relational weight no chaplain can replicate. Show up.
The third is avoidance. Some pastors find deathbeds so emotionally costly that they delegate or postpone them. The dying member of your congregation will know who came and who did not. So will their family for the rest of their lives.
The fourth is manipulation — the last-minute coercive attempt to extract a profession of faith from a dying unbeliever. Do not do this. It produces guilt in the family that lasts for years, and it asks the dying person to perform under duress what cannot be performed that way. Christ at the threshold does not need our manipulation as a backup plan.
The fifth is chatter. Anxious, talkative pastoral care that fills every silence. Learn to be quiet. The dying often need silence more than they need sound.
What is happening, theologically, when a pastor or family member sits at the bedside of someone who is dying? It is easy to underestimate the answer.
You are participating in Christ’s own ministry. You are doing for your brother or sister what Christ does for them, with your hands and voice and presence in the room. You are not the agent of their salvation — Christ is. But you are His witness. You are the visible sign of the invisible Lord who is meeting them. You are the body of Christ in the room.
The medieval church understood this. The Ars Moriendi tradition we surveyed in Chapter 32 assumed that the deathbed was crowded — with family, neighbors, priest, and (the books taught) the saints, the angels, and the Lord Himself. The dying person was not alone. Neither was the companion.
What the NDE evidence is now adding is empirical confirmation of that older intuition. The threshold is real. The encounter is real. The dying person is not entering nothing — they are entering Someone. The companion in the room is not performing a ritual gesture toward an empty space; they are blessing a transition that is actually happening.
A cardiac-arrest patient in one of the prospective studies described what she saw from above her body: her husband holding her hand, her sister praying silently, the resuscitation team working. She also described a quality of the room she could only call its “color” — a peaceful, warm tone that, she said, came from the love in it. After she revived, she told her husband: “Don’t worry. The room was beautiful.”15
This is what your presence is doing, even when you cannot tell. It is filling the room with a quality the patient may be perceiving, even when the body has gone still.
The contemporary American church has largely lost the practice of companioning the dying. Most pastors have never been trained in it formally. Most lay Christians have never been at a bedside. Most families call hospice when the doctor says it is time and otherwise hand the dying off to professionals who do good work but cannot stand in for the body of Christ.
This can be recovered. It is being recovered, in pockets — in particular churches, hospice partnerships, seminary programs that have begun to take pastoral care of the dying as seriously as they take preaching. The recovery is partly a return to old practices and partly a forward step into new knowledge, including what the NDE literature has begun to provide. We now know more about what the dying may be experiencing than the medieval church knew. We can use what we know to be present in the room more wisely than our great-grandparents could.
If you are a pastor reading this: train your elders. Train your deacons. Train your visitation team. Take young pastors with you on bedside visits the way old country doctors used to take medical students into homes. The practice is learnable, but it is learned by doing it.
If you are a family member: you are not in the way. You are exactly the right person. The professionals are there to manage the body. You are there to be the presence of love in the room. That is not a smaller thing than what they are doing. It is the larger thing.
If you are dying yourself, and reading this in advance: your loved ones will not know what to do. Tell them. Tell them now. Tell them which psalms you want read. Tell them which hymns. Tell them you want them to hold your hand and not be afraid of silence. Tell them it is okay to say, when the time comes, “It is okay to go.” You can shape your own deathbed long before you arrive at it.
David, Eleanor’s pastor, sat with her another forty minutes that afternoon. She did not wake. He prayed two more psalms, recited the Lord’s Prayer, and was quiet. He squeezed her hand once before he left. Eleanor died the next morning at 4:47 a.m., with her daughter beside her. The daughter said later that what she remembered most about that last day was not the prayers and not the medicines. It was that her mother’s pastor had come and had not been afraid of the silence. She had felt, for the first time since the diagnosis, that she was not alone in the room.
That is what companioning the dying is. Christ is the one who meets them. We are only the ones who sit with them while they wait. But sitting — truly sitting, present, prayerful, unafraid — is more than most of us know how to do, and more than most of the dying expect to receive. We can learn. We can give it. And in the giving, we are doing what the church has always done at its truest, in its hardest hours: standing beside our brothers and sisters at the threshold, bearing witness to the One who is on the other side, and trusting Him with what comes next.
↑ 1. The Episcopal Church, “Ministration at the Time of Death,” in The Book of Common Prayer (New York: Church Publishing, 1979), 462–67. Among Protestant traditions, the BCP rite remains the most carefully developed liturgical resource for pastoral attendance at a deathbed and is widely used ecumenically.
↑ 2. Allen Verhey, The Christian Art of Dying: Learning from Jesus (Grand Rapids: Eerdmans, 2011), Ch. 1. Verhey traces the slow decline of communal deathbed practice from the Reformation forward and the more rapid loss in the twentieth century. See also Lydia Dugdale, The Lost Art of Dying: Reviving Forgotten Wisdom (New York: HarperOne, 2020), Ch. 1, on the same trajectory from the perspective of contemporary palliative medicine.
↑ 3. On the rise of the modern hospice movement, see David Clark, Cicely Saunders: A Life and Legacy (New York: Oxford University Press, 2018); and Joy Buck, “Rights of Passage: Reforming Care for the Dying, 1965–1986,” The American Journal of Hospice & Palliative Care 28, no. 8 (2011): 575–82. On contemporary pastoral discomfort with the deathbed, see Stanley Hauerwas, Naming the Silences: God, Medicine, and the Problem of Suffering (Grand Rapids: Eerdmans, 1990), Ch. 3.
↑ 4. Henri Nouwen, Our Greatest Gift: A Meditation on Dying and Caring (San Francisco: HarperSanFrancisco, 1994). Nouwen wrote the book in response to caring for his dying friend Maurice Gould; its central image is that the deepest ministry to the dying is simply being there as one human soul beside another.
↑ 5. See Ch. 18 for full treatment of OBE-phase phenomenology, and Ch. 10 for the verifiable cases. The classic catalog is Michael Sabom, Recollections of Death: A Medical Investigation (New York: Harper & Row, 1982), and Sabom’s later Light and Death: One Doctor’s Fascinating Account of Near-Death Experiences (Grand Rapids: Zondervan, 1998), which included the Pam Reynolds case. Bruce Greyson, After: A Doctor Explores What Near-Death Experiences Reveal about Life and Beyond (New York: St. Martin’s Essentials, 2021), Ch. 4, summarizes the contemporary OBE-evidence picture concisely.
↑ 6. The phenomenon of timing one’s death — either holding on for a particular family member or letting go when family steps out — is widely reported by hospice clinicians and is occasionally discussed in the palliative-care literature. See Maggie Callanan and Patricia Kelley, Final Gifts: Understanding the Special Awareness, Needs, and Communications of the Dying (New York: Bantam, 1992), Chs. 5–6; and Christopher Kerr with Carine Mardorossian, Death Is But a Dream: Finding Hope and Meaning at Life’s End (New York: Avery, 2020), 87–90.
↑ 7. Christopher W. Kerr et al., “End-of-Life Dreams and Visions: A Longitudinal Study of Hospice Patients’ Experiences,” Journal of Palliative Medicine 17, no. 3 (2014): 296–303. Kerr’s research at the Center for Hospice and Palliative Care in Buffalo, New York, has now documented thousands of end-of-life experiences and consistently distinguishes them from medication-induced delirium. See also his popular treatment in Death Is But a Dream.
↑ 8. Megory Anderson, Sacred Dying: Creating Rituals for Embracing the End of Life, rev. ed. (New York: Marlowe, 2003), 41–50, on the role of touch in deathbed presence. The hospice nursing literature is consistent on this point.
↑ 9. Job 2:13. Eugene Peterson’s commentary on the friends’ first week of silence — and on what went wrong when they began to speak — remains pastorally instructive: see Peterson, Five Smooth Stones for Pastoral Work (Grand Rapids: Eerdmans, 1980), Ch. 4.
↑ 10. Matthew Friend, Near-Death Experiences as Evidence for Substance Dualism within the Conditional Immortality Debate (Th.D. diss., Trinity College of the Bible and Trinity Theological Seminary, 2025), Ch. 4 (the database analysis); the relevant subset is treated more fully in Ch. 10. The dissertation database catalogues 1,114 cases of accurate distant observation during clinical death, of which a substantial subset includes accurate report of overheard conversation. See also Pim van Lommel et al., “Near-Death Experience in Survivors of Cardiac Arrest: A Prospective Study in the Netherlands,” The Lancet 358 (2001): 2039–45.
↑ 11. The classic recent treatment is Michael Nahm and Bruce Greyson, “Terminal Lucidity in Patients with Chronic Schizophrenia and Dementia: A Survey of the Literature,” Journal of Nervous and Mental Disease 197, no. 12 (2009): 942–44; expanded in Nahm et al., “Terminal Lucidity: A Review and a Case Collection,” Archives of Gerontology and Geriatrics 55, no. 1 (2012): 138–42. Alexander Batthyány continues this line of research at the Viktor Frankl Institute. The phenomenon is biologically unexplained and theologically suggestive.
↑ 12. See Ch. 13. The classic catalog is William Barrett, Death-Bed Visions (London: Methuen, 1926); the contemporary research is summarized in Bruce Greyson, “Seeing Dead People Not Known to Have Died: ‘Peak in Darien’ Experiences,” Anthropology and Humanism 35, no. 2 (2010): 159–71.
↑ 13. See Ch. 34. The pastoral framework there builds on James Beilby, Postmortem Opportunity: A Biblical and Theological Assessment of Salvation After Death (Downers Grove: IVP Academic, 2021); and Stephen Jonathan, Grace Beyond the Grave: Is Salvation Possible in the Afterlife? (Eugene, OR: Wipf and Stock, 2014), Ch. 5.
↑ 14. See again Nahm et al. (2012), and the more recent Andrew Peterson et al., “Terminal Lucidity in Alzheimer’s Disease and Related Dementias,” Alzheimer’s & Dementia 18, no. 5 (2022): 1071–78. The pastoral implication for those caring for dementia patients is significant: a window of clarity in the final hours is not unusual; do not assume the patient’s last conscious word has already been spoken.
↑ 15. Friend, dissertation, Ch. 4 case sub-analysis. The case is one of several in the database in which an experiencer described a perceived “atmosphere” or “quality” of the room during the OBE phase. Cf. the comparable accounts in Penny Sartori, The Near-Death Experiences of Hospitalized Intensive Care Patients: A Five-Year Clinical Study (Lewiston, NY: Edwin Mellen, 2008), Ch. 6.